Tiwari Tejpratap S P, Baughman Andrew L, Clark Thomas A
Meningitis and Bacterial Vaccine Preventable Diseases Branch, Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, and
Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia.
Pediatrics. 2015 Jun;135(6):990-9. doi: 10.1542/peds.2014-2291. Epub 2015 May 4.
American infants are at highest risk of severe pertussis and death. We investigated the role of ≥1 pertussis vaccinations in preventing pertussis-related deaths and risk markers for death among infants aged <42 days.
We analyzed characteristics of fatal and nonfatal infant pertussis cases reported nationally during 1991-2008. Infants were categorized into 2 age groups on the basis of eligibility to receive a first pertussis vaccine dose at age 6 weeks; dose 1 was considered valid if given ≥14 days before illness onset. Multivariable logistic regression was used to estimate the effect of ≥1 pertussis vaccine doses on outcome and risk markers.
Pertussis-related deaths occurred among 258 of 45 404 cases. Fatal and nonfatal cases were confirmed by culture (54% vs 49%) and polymerase chain reaction (31% vs 27%). All deaths occurred before age 34 weeks at illness onset; 64% occurred before age 6 weeks. Among infants aged ≥42 days, receiving ≥1 doses of vaccine protected against death (adjusted odds ratio [aOR]: 0.28; 95% confidence interval [CI]: 0.11-0.74), hospitalization (aOR: 0.69; 95% CI: 0.63-0.77), and pneumonia (aOR: 0.80; 95% CI: 0.68-0.95). Risk was elevated for Hispanic ethnicity (aOR: 2.28; 95% CI: 1.36-3.83) and American Indian/Alaska Native race (aOR: 5.15; 95% CI: 2.37-11.2) and lower for recommended antibiotic treatment (aOR: 0.28; 95% CI: 0.16-0.47). Among infants aged <42 days, risk was elevated for Hispanic ethnicity and lower with recommended antibiotic use.
The first pertussis vaccine dose and antibiotic treatment protect against death, hospitalization, and pneumonia.
美国婴儿患重症百日咳和死亡的风险最高。我们调查了≥1剂百日咳疫苗在预防<42日龄婴儿百日咳相关死亡中的作用以及死亡的风险标志物。
我们分析了1991 - 2008年全国报告的致命和非致命婴儿百日咳病例的特征。根据婴儿在6周龄时是否有资格接种第一剂百日咳疫苗，将婴儿分为2个年龄组；如果在发病前≥14天接种，第1剂疫苗被视为有效。采用多变量逻辑回归来估计≥1剂百日咳疫苗对结局和风险标志物的影响。
45404例病例中有258例发生百日咳相关死亡。致命和非致命病例通过培养确诊的比例分别为54%和49%，通过聚合酶链反应确诊的比例分别为31%和27%。所有死亡均发生在发病时34周龄之前；64%发生在6周龄之前。在≥42日龄的婴儿中，接种≥1剂疫苗可预防死亡（调整优势比[aOR]：0.28；95%置信区间[CI]：0.11 - 0.74）、住院（aOR：0.69；95% CI：0.63 - 0.77）和肺炎（aOR：0.80；95% CI：0.68 - 0.95）。西班牙裔（aOR：2.28；95% CI：1.36 - 3.83）和美国印第安人/阿拉斯加原住民种族（aOR：5.15；95% CI：2.37 - 11.2）的风险升高，而推荐使用抗生素治疗的风险降低（aOR：0.28；95% CI：0.16 - 0.47）。在<42日龄的婴儿中，西班牙裔的风险升高，而推荐使用抗生素时风险降低。
第一剂百日咳疫苗和抗生素治疗可预防死亡、住院和肺炎。
